Transforming the Psychiatrist's Office

New technologies for treating depression could make the couch obsolete.

The iconic symbol of the psychiatrist's office--the psychoanalyst's couch--could soon be supplemented with new medical devices that can help doctors treat patients or objectively assess how treatment is progressing. Two experimental devices--one to treat patients with drug-resistant depression, and one that can quickly assess if a particular medication is working--are currently in late-stage clinical development. They could transform psychiatry from a specialty practiced largely with a prescription pad into one that more closely resembles a typical medical specialty.

Brain waves: Electrodes are applied to a volunteer’s forehead and temples to record brain activity from the part of the frontal cortex involved in mood. The device, currently in clinical trials, is designed to quickly predict if patients will respond to an antidepressant. Credit: Aspect Medical Systems

"Psychiatrists don't do procedures; they do talk therapy and write scripts," says Mark Bausinger, chief financial officer of Neuronetics, a medical-device company based in Malvern, PA, that is developing a noninvasive treatment device. "So this is really going to change the way they work."

While antidepressants such as Prozac and Lexapro have been a huge boon to the treatment of depression, they possess some serious limitations. Antidepressants can take weeks or months to exert their full benefit, and different patients respond to different drugs. Because doctors have no way to predict the best drug for a particular patient, many people spend months or even years switching or tweaking their prescriptions to find the drug or combination best suited to them. In addition, recent studies have shown that about a third of patients do not respond to any medication they try, leaving them with options such as electroconvulsive therapy (ECT), which is effective but carries serious side effects.

A new device that measures brain waves could help solve the first problem. While it may take patients several weeks of medication to feel better, previous research has shown that brain-activity changes measured via electroencephalogram (EEG) can, within just one week, predict if that medicine will help. Patients who are likely to improve show a decrease in activity in certain parts of the brain.

In 2001, Aspect Medical Systems, a neurotechnology company based in Norwood, MA, began developing a commercial version of this EEG technology. Requiring only five electrodes to be placed on a subject's forehead and temples, rather than 20 or more electrodes scattered over the entire scalp, the device is much easier to use than the EEG systems typically employed in research labs.

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The company is now sponsoring a large, multicenter clinical trial to determine if the device can reliably detect antidepressant response. Initial results from the study, presented this week in San Diego at a meeting of the American Psychiatric Association, are promising. After a week of treatment, the device could predict if a particular drug would work in the longer term 70 to 80 percent of the time.

"Psychiatry is the last specialty without a good diagnostic test to guide treatment," says Andrew Leuchter, a researcher and psychiatrist at the University of California, Los Angeles, and a study leader. "I think there is a lot of enthusiasm for a quick test that can be carried out in the doctor's office and inform treatment." Leuchter's group did some of the early research underlying the device, and he heads Aspect's science advisory board.